How understanding the menstrual cycle makes pregnancy easier for trying couples

It was my pleasure to attend to a certain couple from the eastern part of the country a few years ago. Mr B. J was a young insurance broker residing in Ibadan with his wife but working in Lagos. He travels to Lagos first thing on Monday morning and is not back in Ibadan to join his wife until around noon on Saturday every week. They had been married for almost 4 years without a child. Having done quite a number of tests, their case sounded like another case of unexplained infertility as everything seemed fine medically but there was still no conception. Fortunately, Mrs B. J kept a menstrual calendar and had done so since the beginning of her period.

On further evaluation, I observed that Mrs B. J begins to ovulate on Wednesday and by Saturday, when her husband is back from Lagos, a possible “fertilization party” is as good as over before it  starts. After due counseling about the ovulation cycle and effective intercourse periods, they achieved natural conception within three months. It was my pleasure to deliver the healthy baby boy nine months after. They have since gone ahead to have two more beautiful girls.

The monthly cycle of a woman otherwise referred to as the menstrual cycle is controlled by chemicals released from the brain (hormones) which acts on the womb (uterus) and the ovaries (the store house of the eggs). These chemicals recruit a number of eggs from the ovaries and goes on to select the best of the recruited eggs for release around the middle of the cycle. The released egg awaits fertilisation by a sperm for a maximum of 24-36 hours, without fertilization, the egg dies off and there can be no conception till the next cycle.

In the meantime, the hormones continue to be released from the brain and prepare the womb to receive the fertilized egg. If there is no fertilized egg (conception) the lining of the womb is shed in what is referred to as the menstrual flow. The menstrual flow has been aptly described as the “weeping of the disappointed uterus” and sighting of the menstrual flow more or else confirms lack of conception for that month.

An understanding of the menstrual cycle will allay quite a number of fears that couples intending to conceive have and would also help them to understand available options of treatment. These things are taught in schools but their relevance to daily life outside the schools should be emphasized. What saved the day for the couple was the fact that Mrs B. J kept a book in which she noted her menstrual pattern. Young ladies should be encouraged to do this from the earliest possible age.

In this article, we will examine the common abnormalities that can happen with the menstrual cycle and such abnormalities can affect pregnancy or conception.

Irregular menstrual flow 

Women have an average cycle length. This is obtained by adding together the cycle length for six months and dividing by the result by six. The value a woman gets is her average cycle length. This value plus or minus four gives the range of her cycle. For instance, if a woman’s average cycle length is 31, then the range for her menstrual flow plus or minus four will give 27 to 35. If her menstrual cycle falls within that range, it is considered regular but when it falls outside that range, it is considered irregular. It is normal for menstrual cycles to be irregular in the first year of commencement of menses and towards cessation (menopause). At other times, it is considered abnormal. The most common cause of irregular menstrual flow is irregular ovulation. This can be associated with conditions such as polycystic ovarian syndrome, thyroid diseases, underweight women or overweight women. If menstrual flows are irregular, it suggests that ovulation is irregular and this will certainly affect chances of conception.

Painful menstrual flow

The menstrual flow causes mild discomfort in most women which is usually relieved by simple analgesics obtained over-the-counter. However, when this pain becomes so severe, warranting hospital admission and/or causing ladies to miss work or classes, it should be looked into as it may be a sign that all is not well. The most common cause of severely painful menstrual flow is endometrosis. Unfortunately, Africans think endometriosis is a disease of the western world but this is not so. We are having more and more people come up with the diagnosis in our daily practice in Nigeria. Uterine fibroids may also cause painful menstrual flow especially if it’s a sub-mucous fibroid or a fibroid polyp.

Heavy menstrual flow

Every woman has what is normal for her in terms of quantity and duration of flow. However, if there is a significant increase in the volume of the flow, something may be wrong. This is suggested when sanitary towels are changed more than 5 times a day and the flow is associated with clots, dizziness or fainting attacks.

All of these points to the fact that the flow is tending towards being excessively heavy and should medically checked. Uterine fibroids, endometriosis, irregular periods and some hormonal problems may cause heavy menstrual flow and all of these will also reduce chances of conception.

Scanty menstrual flow

Every woman has what is normal for her in terms of quantity but when there is a significant reduction in the volume of menstrual flow,  it suggests there has been an injury to the of the lining of the womb. This is even more likely after a surgery such a fibroid surgery, a caesarean section or even an evacuation of the uterus. At other times, a severe infection of the womb can cause this. This is quite difficult to treat and is better prevented. It will cause difficulty in conception and repeated abortions.

Absent menstrual flow

Most young girls will start menstrual flow around the age of 12 or 13 years and will continue till 48 or 50 years. The most common cause of a missed period is pregnancy. However, there are women who have never menstruated. Understanding the cause of such condition will depend on a number of factors like if they have other female sex characteristics such as adequate breast development, pubic/auxiliary hair and body contours. Such women will need to have hormonal testing done and an examination of their female pelvic organs by laparoscopy must be carried out. When cessation of menstrual flow occurs before the age of 40 years, it is regarded as premature menopause. This situation is more common than is actually known.

Mid-cycle complaints

Around the middle of the cycle, there may be minimal vaginal bleeding and cramps. These are indicative of release of the egg (ovulation) they are self limiting and do not last more than 24 or 48 hours. If anything, it is a confirmation of ovulation.